MEDICARE: ADRIANA PENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1285597492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANA PENA

Provider Business Mailing Address
First Line	:	158 BEESLEY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5002
Country	:	US
Telephone Number	:	702-964-5976
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-0355
Country	:	US
Telephone Number	:	702-502-8021
Fax Number	:	888-688-9464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ ADRIANA PENA ” Practice Location

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